The value of serum osteoprotegerin levels in patients with angina like chest pain undergoing diagnostic coronary angiography

Background: Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily.Recent evidence supports a relationship between serum OPG level and atherosclerosis. Theaim of this study was to evaluate the possible association of OPG with the presence of coronary artery disease (CAD), its severity and prognosis in patients with chest pain and suspected coronary stenosis.Methods: In this cross-sectional analytic study, 180 candidates of elective coronary artery angiography were recruited. Serum level of OPG was measured by ELISA method in all patientsand its relation with presence and severity of CAD based on a coronary atherosclerosis score (CAS) was assessed. Patients were followed for a mean period of about 24 ± 3.2 months andthe relationship between OPG levels and future cardiac events were evaluated.Results: The mean serum level of OPG was 1637 ± 226 pg/mL in those with CAD and 1295 ± 185 pg/mL (nonparametric p = 0.001) in those without it. There was a significant directcorrelation between the level of serum OPG and CAS (rho = 0.225, p = 0.002). The optimalcut-off point for predicting a significant coronary artery obstruction was a serum level of ≥ 1412 pg/mL with a sensitivity and specificity of 60% and 57.8%, respectively. Major adversecardiac events (MACE) including cardiovascular death, admission with acute coronary syndrome,or heart failure, was significantly higher in those with higher OPG levels (22 [34.3%]vs. 15 [16%], p = 0.012).Conclusions: There was a direct and significant correlation between the serum level of OPGand CAS. MACE occurred more commonly in those with higher baseline OPG levels

Chloride in Heart Failure:The Neglected Electrolyte

The increasing burden of heart failure (HF) and emerging knowledge regarding chloride as a prognostic marker in HF have increased the interest in the pathophysiology and interactions of chloride abnormalities with HF-related factors and treatments. Chloride is among the major electrolytes that play a unique role in fluid homeostasis and is associated with cardiorenal and neurohormonal systems. This review elucidates the role of chloride in the pathophysiology of HF, evaluates the effects of treatment on chloride (eg, diuretic agents cause higher urinary chloride excretion and consequently serum hypochloremia), and discusses recent evidence for the association between chloride levels and mortality

A novel computerised quantification of thyroid vascularity in the differentiation of malignant and benign thyroid nodules

Purpose: Only five percent of thyroid nodules are malignant. It is important to find reliable and at the same time non-invasive methods to identify high-risk nodules. The aim of this study was to determine the diagnostic validity of a morphologic feature-oriented approach of ultrasound study for the identification of malignant thyroid nodules. Material and methods: Seventy-one thyroid nodules in 71 consecutive patients were evaluated with both ultrasonography (US) and US-assisted fine needle aspiration biopsy (FNAB). Thyroid grey-scale and power Doppler US were performed, and a Windows-based software was designed to process power Doppler US (PDUS) images that were recorded directly by the US device. We provided a histogram graph of coloured pixels and calculated the Malignancy Index to identify the probability of malignancy for each thyroid nodule. Results: Thirty-six nodules (50.7%) were determined to be malignant in FNAB. Area under the receiver operating curve was 0.91 (95% CI: 0.85-0.98) for PDUS-based malignancy index in differentiating malignant thyroid nodules from benign ones. The best cut-off point for malignancy index was determined to be 0.092, with a sensitivity of 86.1% and specificity of 80% in identifying malignant nodules. Conclusions: This PDUS-driven malignancy index using a contour-finding algorithm approach could accurately and reliably differentiate malignant and benign thyroid nodules. As a pre-FNAB assessment, the malignancy index may be able to reduce the number of patients with nodular thyroid disease undergoing this invasive procedure

Is There Any Interaction Between Sex and Renal Function Change During Hospital Stay in Patients Hospitalized With Acute Heart Failure?

Background: Renal dysfunction is a strong predictor of outcomes in patients with acute heart failure (AHF). However. less is known about how sex may influence the prognostic import of renal function in AHF. Methods and Results: In a post hoc analysis of the ASCEND-HF trial including 5377 patients with AHF (33% female), patients were categorized into 3 groups based on the changes in renal function during their hospital stay. Worsening. stable, and improving renal functions were defined as a >= 20% decrease, a = 20% increase in the estimated glomentlar filtration rate, respectively. The primary outcome was the composite of 30-day all-cause mortality or HF rehospitalization. The median baseline and discharge estimated glomerular filtration rate were 58.4 and 56.9 mL/min/l.73 m(2), respectively. Worsening, stable, and improving renal function was observed in 31.9%, 63.2, and 4.9% of patients. respectively. Worsening renal function was associated with adverse outcomes at 30 days (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.22-1.76). This association existed in both males and females (aHR 1.42 and aHR 1.56, respectively, both P < .01). There was an interaction between renal function changes and sex (P = .025), because improving renal function was associated with better outcomes in men(aHR 0.29, 95% CI 0.13 0.66) as compared with women (aHR 1.18, 95% CI 0.59 2.35). There was no interaction between the ejection fraction and renal function in association with subsequent outcomes. Conclusions: Irrespective of sex, worsening renal function was associated with poorer outcomes at 30 days in patients with AHF. More studies are warranted to further delineate the possible sex differences in this setting

Survey of Hepatitis B Status in Hemodialysis Patients in a Training Hospital in Urmia, Iran

To evaluate the prevalence of HBV infection in chronic hemodialysis patients at our dialysis center of Urmia&#x2032;s Taleqni Hospital, Urmia, Iran, we studied cross-sectionally the hepatitis surface antigen (HbsAg) status in blood samples of 167 active chronic hemodialysis patients at our center with enzyme linked immunosorbant assay (ELISA). The mean frequency of HbsAg&#x002B; was 6.58&#x0025;, which was higher in patients less than 50 years old than in those above 50 years (9.3&#x0025; vs. 5.3&#x0025;, respectively), in males than females (10.5&#x0025; vs. 2.5&#x0025;, respectively), and in those on three times dialysis than twice per week (7.1&#x0025; vs. 0.0&#x0025;, respectively). We did not find a significant relationship between the factors of: age, sex, being resident in city or village, duration of the therapy, history of blood transfusion, marital status, job status, history of kidney transplantation, and preva-lence of HbsAg&#x002B;

Pulmonary sequestration: A rare case in a patient with acute chest pain and palpitation mimicking the acute coronary syndrome

Pulmonary sequestration (PS), a non-functioning lung tissue, which lacks the normal communication with the tracheobronchial tree and receives the blood supply from the systemic circulation, is a rare congenital malformation that comprises 0.5-6% of all congenital pulmonary malformations. The presentation of PS with chest pain is very rare. In this article, we are aimed to report the case of a patient with chief complaints of retrosternal chest pain and palpitation, which was suspected to be of cardiac origin. Primary evaluations including exercise tolerance test, 48-hour holter monitoring, coronary angiography ruled out any cardiac problem. Further evaluations with Thoracic CT scan revealed a cystic mass in the retrocardiac region of the lung. Thoracotomy surgery was done and the patient was finally diagnosed to be extralobar pulmonary sequestration